UMASS_BioNLP at MEDIQA-Chat 2023: Can LLMs generate high-quality synthetic note-oriented doctor-patient conversations?

This paper presents UMASS_BioNLP team participation in the MEDIQA-Chat 2023 shared task for Task-A and Task-C. We focus especially on Task-C and propose a novel LLMs cooperation system named a doctor-patient loop to generate high-quality conversation data sets. The experiment results demonstrate that our approaches yield reasonable performance as evaluated by automatic metrics such as ROUGE, medical concept recall, BLEU, and Self-BLEU. Furthermore, we conducted a comparative analysis between our proposed method and ChatGPT and GPT-4. This analysis also investigates the potential of utilizing cooperation LLMs to generate high-quality datasets.

Referring to Screen Texts with Voice Assistants

Voice assistants help users make phone calls, send messages, create events, navigate, and do a lot more. However, assistants have limited capacity to understand their users' context. In this work, we aim to take a step in this direction. Our work dives into a new experience for users to refer to phone numbers, addresses, email addresses, URLs, and dates on their phone screens. Our focus lies in reference understanding, which becomes particularly interesting when multiple similar texts are present on screen, similar to visual grounding. We collect a dataset and propose a lightweight general-purpose model for this novel experience. Due to the high cost of consuming pixels directly, our system is designed to rely on the extracted text from the UI. Our model is modular, thus offering flexibility, improved interpretability, and efficient runtime memory utilization.

5IDER: Unified Query Rewriting for Steering, Intent Carryover, Disfluencies, Entity Carryover and Repair

Providing voice assistants the ability to navigate multi-turn conversations is a challenging problem. Handling multi-turn interactions requires the system to understand various conversational use-cases, such as steering, intent carryover, disfluencies, entity carryover, and repair. The complexity of this problem is compounded by the fact that these use-cases mix with each other, often appearing simultaneously in natural language. This work proposes a non-autoregressive query rewriting architecture that can handle not only the five aforementioned tasks, but also complex compositions of these use-cases. We show that our proposed model has competitive single task performance compared to the baseline approach, and even outperforms a fine-tuned T5 model in use-case compositions, despite being 15 times smaller in parameters and 25 times faster in latency.

Revisiting the Architectures like Pointer Networks to Efficiently Improve the Next Word Distribution, Summarization Factuality, and Beyond

Is the output softmax layer, which is adopted by most language models (LMs), always the best way to compute the next word probability? Given so many attention layers in a modern transformer-based LM, are the pointer networks redundant nowadays? In this study, we discover that the answers to both questions are no. This is because the softmax bottleneck sometimes prevents the LMs from predicting the desired distribution and the pointer networks can be used to break the bottleneck efficiently. Based on the finding, we propose several softmax alternatives by simplifying the pointer networks and accelerating the word-by-word rerankers. In GPT-2, our proposals are significantly better and more efficient than mixture of softmax, a state-of-the-art softmax alternative. In summarization experiments, without significantly decreasing its training/testing speed, our best method based on T5-Small improves factCC score by 2 points in CNN/DM and XSUM dataset, and improves MAUVE scores by 30% in BookSum paragraph-level dataset.

Vision Meets Definitions: Unsupervised Visual Word Sense Disambiguation Incorporating Gloss Information

Visual Word Sense Disambiguation (VWSD) is a task to find the image that most accurately depicts the correct sense of the target word for the given context. Previously, image-text matching models often suffered from recognizing polysemous words. This paper introduces an unsupervised VWSD approach that uses gloss information of an external lexical knowledge-base, especially the sense definitions. Specifically, we suggest employing Bayesian inference to incorporate the sense definitions when sense information of the answer is not provided. In addition, to ameliorate the out-of-dictionary (OOD) issue, we propose a context-aware definition generation with GPT-3. Experimental results show that the VWSD performance significantly increased with our Bayesian inference-based approach. In addition, our context-aware definition generation achieved prominent performance improvement in OOD examples exhibiting better performance than the existing definition generation method. We will publish source codes as soon as possible.

Boosting Few-Shot Text Classification via Distribution Estimation

Distribution estimation has been demonstrated as one of the most effective approaches in dealing with few-shot image classification, as the low-level patterns and underlying representations can be easily transferred across different tasks in computer vision domain. However, directly applying this approach to few-shot text classification is challenging, since leveraging the statistics of known classes with sufficient samples to calibrate the distributions of novel classes may cause negative effects due to serious category difference in text domain. To alleviate this issue, we propose two simple yet effective strategies to estimate the distributions of the novel classes by utilizing unlabeled query samples, thus avoiding the potential negative transfer issue. Specifically, we first assume a class or sample follows the Gaussian distribution, and use the original support set and the nearest few query samples to estimate the corresponding mean and covariance. Then, we augment the labeled samples by sampling from the estimated distribution, which can provide sufficient supervision for training the classification model. Extensive experiments on eight few-shot text classification datasets show that the proposed method outperforms state-of-the-art baselines significantly.

Enhancing the prediction of disease outcomes using electronic health records and pretrained deep learning models

Question: Can an encoder-decoder architecture pretrained on a large dataset of longitudinal electronic health records improves patient outcome predictions? Findings: In this prognostic study of 6.8 million patients, our denoising sequence-to-sequence prediction model of multiple outcomes outperformed state-of-the-art models scuh pretrained BERT on a broad range of patient outcomes, including intentional self-harm and pancreatic cancer. Meaning: Deep bidirectional and autoregressive representation improves patient outcome prediction.

Associations Between Natural Language Processing (NLP) Enriched Social Determinants of Health and Suicide Death among US Veterans

Importance: Social determinants of health (SDOH) are known to be associated with increased risk of suicidal behaviors, but few studies utilized SDOH from unstructured electronic health record (EHR) notes. Objective: To investigate associations between suicide and recent SDOH, identified using structured and unstructured data. Design: Nested case-control study. Setting: EHR data from the US Veterans Health Administration (VHA). Participants: 6,122,785 Veterans who received care in the US VHA between October 1, 2010, and September 30, 2015. Exposures: Occurrence of SDOH over a maximum span of two years compared with no occurrence of SDOH. Main Outcomes and Measures: Cases of suicide deaths were matched with 4 controls on birth year, cohort entry date, sex, and duration of follow-up. We developed an NLP system to extract SDOH from unstructured notes. Structured data, NLP on unstructured data, and combining them yielded seven, eight and nine SDOH respectively. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression. Results: In our cohort, 8,821 Veterans committed suicide during 23,725,382 person-years of follow-up (incidence rate 37.18 /100,000 person-years). Our cohort was mostly male (92.23%) and white (76.99%). Across the six common SDOH as covariates, NLP-extracted SDOH, on average, covered 84.38% of all SDOH occurrences. All SDOH, measured by structured data and NLP, were significantly associated with increased risk of suicide. The SDOH with the largest effects was legal problems (aOR=2.67, 95% CI=2.46-2.89), followed by violence (aOR=2.26, 95% CI=2.11-2.43). NLP-extracted and structured SDOH were also associated with suicide. Conclusions and Relevance: NLP-extracted SDOH were always significantly associated with increased risk of suicide among Veterans, suggesting the potential of NLP in public health studies.

Automated Identification of Eviction Status from Electronic Health Record Notes

Objective: Evictions are involved in a cascade of negative events that can lead to unemployment, homelessness, long-term poverty, and mental health problems. In this study, we developed a natural language processing system to automatically detect eviction incidences and their attributes from electronic health record (EHR) notes. Materials and Methods: We annotated eviction status in 5000 EHR notes from the Veterans Health Administration. We developed a novel model, called Knowledge Injection based on Ripple Effects of Social and Behavioral Determinants of Health (KIRESH), that has shown to substantially outperform other state-of-the-art models such as fine-tuning pre-trained language models like BioBERT and Bio_ClinicalBERT. Moreover, we designed a prompt to further improve the model performance by using the intrinsic connection between the two sub-tasks of eviction presence and period prediction. Finally, we used the Temperature Scaling-based Calibration on our KIRESH-Prompt method to avoid over-confidence issues arising from the imbalance dataset. Results: KIRESH-Prompt achieved a Macro-F1 of 0.6273 (presence) and 0.7115 (period), which was significantly higher than 0.5382 (presence) and 0.67167 (period) for just fine-tuning Bio_ClinicalBERT model. Conclusion and Future Work: KIRESH-Prompt has substantially improved eviction status classification. In future work, we will evaluate the generalizability of the model framework to other applications.

Multi-label Few-shot ICD Coding as Autoregressive Generation with Prompt

Automatic International Classification of Diseases (ICD) coding aims to assign multiple ICD codes to a medical note with an average of 3,000+ tokens. This task is challenging due to the high-dimensional space of multi-label assignment (155,000+ ICD code candidates) and the long-tail challenge - Many ICD codes are infrequently assigned yet infrequent ICD codes are important clinically. This study addresses the long-tail challenge by transforming this multi-label classification task into an autoregressive generation task. Specifically, we first introduce a novel pretraining objective to generate free text diagnoses and procedure using the SOAP structure, the medical logic physicians use for note documentation. Second, instead of directly predicting the high dimensional space of ICD codes, our model generates the lower dimension of text descriptions, which then infer ICD codes. Third, we designed a novel prompt template for multi-label classification. We evaluate our Generation with Prompt model with the benchmark of all code assignment (MIMIC-III-full) and few shot ICD code assignment evaluation benchmark (MIMIC-III-few). Experiments on MIMIC-III-few show that our model performs with a marco F1 30.2, which substantially outperforms the previous MIMIC-III-full SOTA model (marco F1 4.3) and the model specifically designed for few/zero shot setting (marco F1 18.7). Finally, we design a novel ensemble learner, a cross attention reranker with prompts, to integrate previous SOTA and our best few-shot coding predictions. Experiments on MIMIC-III-full show that our ensemble learner substantially improves both macro and micro F1, from 10.4 to 14.6 and from 58.2 to 59.1, respectively.